For months, officials at Los Angeles County-USC Medical Center have been buzzing with excitement about the anticipated opening of their new home. But that opening has been delayed repeatedly. There are two main concerns loom over the $1.02-billion medical center's opening: Are there too few beds, and will there be enough doctors to fully staff the expanded emergency room when it opens?
Barack Obama has sharply criticized John McCain's healthcare proposals, saying they could force millions of Americans to struggle to buy medical insurance. Obama gave a detailed outline of his own plans in a 40-minute speech at a waterside park in Newport News, VA. Obama told the thousands in attendance that he would make coverage more affordable to most Americans, he said, paying for the subsidies largely by canceling the Bush administration's tax cuts for people making more than $250,000 a year.
Officials of University Medical Center at Princeton, NJ, have broken ground on a $441 million hospital in Plainsboro. The facility will be the centerpiece of a 160-acre campus that will also see job creation and housing. Planned for a 50-acre tract, the University Medical Center of Princeton at Plainsboro, as the new facility is called, will replace the existing acute-care hospital in downtown Princeton. The new 238-bed hospital features all private rooms and a design that takes advantage of natural light and surroundings, said Barry Rabner, president and CEO of Princeton HealthCare System. Rabner added that the facility will "redefine how care is delivered in New Jersey."
Mike Herrera's pain was growing as he walked into the emergency department of Dallas-based Parkland Memorial Hospital on a recent evening. But it wasn't until he collapsed in an exam room 19 hours after he was admitted that the staff seemed to spring into action, his family says. Herrera's death follows years of warnings about excessive wait times in the emergency department of the hospital, which serves the indigent and others without health insurance. A 2004 study on the hospital said wait times in Parkland's ER were so excessive that more than one in 10 patients left the hospital before seeing a doctor.
A recent survey has found that employer-sponsored health insurance premiums have jumped 5% over 2007. Many companies have been offering plans with higher deductibles to address rising health insurance costs. These cost increases are being driven by a struggling economy, and are pushing many to cut back on healthcare.
Hospital human resources professionals across the nation are expected to play a role in determining effective staffing levels to identify and reduce healthcare-associated infections.
Good luck!
No one denies the seriousness of the problem. HAIs strike more than 2 million patients in U.S. hospitals each year and play a role in the deaths of nearly 90,000 patients—one death every six minutes—making HAIs the fifth-leading cause of death at acute-care hospitals, according to reports.
With that much at risk, you'd think there'd be a formula for determining whether or not your hospital is properly staffed for infection control. Something like: "X number of patients requires Y number of infection control staff." Nope. It's not that simple. There doesn't even appear to be a good rule of thumb out there anymore. CMS' longstanding "Study on the Efficacy of Nosocomial Infection Control," for example, recommends staffing at least one infection control specialist for every 250 occupied beds. But that report was published in 1980 and is widely considered to be dangerously obsolete.
At a one-day workshop held in August at Leiden University Medical Centre in the Netherlands, a panel of infection control experts agreed that one full-time infection control practitioner was needed for every 178 hospital beds. But the panel also questioned the validity of basing HAI staffing needs purely on the number of beds.
It gets worse. A new HAI study published this month in Healthcare Epidemiology reviews scores of previous HAI studies and determines that more HAI studies are needed. Ugh!
The report, Hospital Staffing and Health Care-associated Infections: A Systematic Review of the Literature, found that hundreds of previous HAI studies were either flawed, or were pretty much useless beyond a small set of comparisons. About the only thing the researchers could glean from the 42 studies it could accurately compare was a correlation between HAIs and levels of staffing, particularly of nurses, their level of training, and their familiarity with their particular environment. Thus, more, better-trained and permanent staff nurses appear to reduce HAIs. This is not news.
All this uncertainty about infection-control staffing levels comes as CMS this month begins a clamp down on reimbursements for HAIs, and as the media cranks out more and more stories about deadly "super bugs" and other hospital-borne health threats.
"It would be nice to say there is a magic bullet out there, just hire this many staff and your problem is solved, but that's not the case," say Gina Pugliese, vice president of Premier Safety Institute. "Maybe there shouldn't be a specific number of practitioners per bed unless it's really researched. You have to look at the acuity of the patients, and the numbers and types of units and the patient populations and their risk factors before you can decide what kind of infection-control staffing you need."
Until new research offers more-concrete staffing guidelines and other strategies, hospitals may well be on their own in the war against HAIs. In the meantime, the Association of Professionals in Infection Control and Epidemiology is suggesting a cultural change in the way hospital leadership addresses HAIs. APIC and Premier two weeks ago completed a survey of 930 infection preventionists nationwide, and only 15% of the respondents said their executive and physician leadership are actively engaged in fighting infections at their hospitals.
Given the scope of the problem, those survey results are staggering.
"Healthcare leaders must make infection prevention a priority and allocate resources to efforts that target institution-wide prevention, education, measurement and process improvements," says Kathy Warye, APIC's CEO.
Either that, or they can wait around for another study.
John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
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Judy Chatigny, R.N., M.S.N., a seasoned healthcare administrator, has joined City of Hope as vice president of patient access services. Chatigny will focus on streamlining access to care and patient services. She comes to City of Hope from Loma Linda University Medical Center's cancer institute, where she served as executive director.
Spectrum Health has named James Tucci, M.D., to lead its newly formed physician group. Tucci, who joined Spectrum a year ago as vice president of medical affairs and quality for the health's system Hospital Group, now oversees all operation of the new Spectrum Health Medical Group.
Dale Hustedt has been named interim CEO Rice Memorial Hospital.
Hustedt, who is currently the hospital's associate administrator for facility and human resources, will take temporary leadership of the city-owned hospital until a new, permanent CEO can be found. He replaces Lawrence J. Massa.
University Hospitals and Health Centers named chief financial officer Doug Strong as the medical system's new interim CEO, after Larry Warren retired from the post last month. While Strong began his duties Oct. 1, a nationwide search to find a permanent CEO may take six to nine months.
